Reducing Anesthesia and Health Care Cost through Utilization of Child Life Specialists in Pediatric Radiation Oncology

Publication date: Available online 5 June 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Michael T. Scott, Kimberly E. Todd, Heather Oakley, Julie Bradley, Ronny Rotondo, Christopher G. Morris, Stuart Klein, Nancy P. Mendenhall, Daniel J. Indelicato
PurposeDuring a typical 6-week course of radiotherapy, daily anesthesia for immobilization of young children increases the cost of treatment. Through education and therapeutic play interventions, a certified child life specialist (CCLS) may reduce the need for daily anesthesia. This report quantifies the healthcare payer cost savings of CCLS utilization in the U.S.Materials/MethodsFrom 2006-2014, 738 children (age ≤21 years) were treated with radiotherapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients age 0-2 and >12 years. In the analyzed cohort of 425 patients, the median age was 7.6 years (range, 3–12.9 years). For the pre-CCLS period, the overall median age was 7.5 years; for the post-CCLS period, the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiotherapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000.ResultsBefore employing a CCLS, 69 of 121 (57%) children ages 3-12 required daily anesthesia, including 33 of 53 (62.3%) children ages 5-8 years. After employing a CCLS, 124 of 304 (40.8%) children ages 3-12 required daily anesthesia, including only 34 of 118 (28.8%) children ages 5-8 years (p<0.0001).With a >16% absolute reduction in anesthesia use after employment of a CCLS, the healthcare payer cost savings was approaching $50,000 per 6 children ages 3-12 treated annually with radiotherapy in our institution. This reduction resulted in a total of only 6 children ages 3-12 who required to be treated per year at our center to achieve nearly break-even cost savings to the healthcare payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized healthcare payer cost savings of "$[(Anesthesia cost to payer during radiotherapy course/6) – (CCLS expense to payer/N)]" per child (N) treated with radiotherapy where N equals the number of children ages 3-12 treated in one year. This formula assumes that the payer subsidize the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized healthcare system cost savings from reducing the frequency of anesthesia with radiotherapy when treating 100 children ages 3-12 per year could exceed $775,000.ConclusionsThis data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiotherapy. Healthcare system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiotherapy centers.

Teaser

For young children treated with radiotherapy, daily anesthesia required for immobilization increases the cost of treatment and adds potential long-term morbidity. Through education and therapeutic play interventions, a certified child life specialist (CCLS) reduces the need for daily anesthesia, particularly in children ages 3-8 years. The CCLS intervention results in significant healthcare cost savings to the payer and eliminates unnecessary potential risks from weeks of daily anesthesia.


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